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Correspondence

Indian Pediatr 2016;53: 934-935

Immune Thrombocytopenia Following Diphtheria-Pertussis- Tetanus and Oral Polio Vaccine

 

Arijit Bhowmik and *Tamoghna Biswas

Department of Pediatric Medicine,  Medical College Kolkata, India.
Email: [email protected]

 


Post-vaccination immune thrombocytopenia has been reported to occur with a number of vaccines, of which mumps measles and rubella (MMR) vaccine appear to be most common. We report a case of immune thrombo-cytopenia following concurrent immunization with diphtheria-pertussis-tetanus (DPT) and oral polio (OPV) vaccines.

A 3.5-month-old boy presented with generalized pupuric rash appearing six days following immunization with third dose of DPT and OPV. There was no history of any rash after previous doses of the same vaccines. On examination, there was non-blanching reddish macular rash over trunk and extremities, but no associated fever, lymphadenopathy, hepatosplenomegaly, sternal tender-ness or external bleeding manifestations. Investigations revealed a hemoglobin level of 12.4 g/dL, total leucocyte count 11.3×109/L (neutrophil 52%, lymphocyte 45%, eosinophil 2%), and platelet 8×109/L. Liver and renal function tests were normal, and tests for anti-nuclear antibody were negative. Peripheral smear examination revealed no significant abnormality. Bone marrow examination showed normal granulocytic and erythro-cytic series, with increased numbers of megakaryocytes. The child was treated with a single dose of intravenous immunoglobulin (1g/kg). The rashes gradually disappeared after 3-4 days. Within 3 days, platelet count increased to 52×109/L with complete normalization occurring within 7 days. On follow-up, patient was healthy and booster dose of DPT/ OPV at 18 months of age was uneventful.

Immune thrombocytopenic purpura (ITP) is generally rare after immunization. In a study from Canada, 75% of such cases followed a measles-containing vaccine [1]. DTP or OPV vaccines are less commonly associated with ITP. Arya, et al. [2] reported thrombocytopenic purpura following DPT vaccination. In their retrospective series of 20 cases, Hsieh, et al. [3] also reported 4 cases of ITP after the first dose of diphtheria-tetanus-acellular pertussis-containing vaccine in early infancy. Other authors [4,5] have also documented the occurrence of ITP after OPV. In our case, it was not possible to implicate the individual vaccine causing thrombo-cytopenia due to concurrent administration of both as per National Immunization schedule.

 

References

1. Jadavji T, Scheifele D, Halperin S; Canadian Paediatric Society/Health Cananda Immunization Monitoring Program. Thrombocytopenia after immunization of Canadian children, 1992 to 2001. Pediatr Infect Dis J. 2003;22:119-22.

2. Arya LS, Ghai OP, Saraya AK. Thrombocytopenic purpura following DPT vaccination. Pediatr Hematol Oncol. 1993;10:381-3.

3. Hsieh YL, Lin LH. Thrombocytopenic purpura following vaccination in early childhood: experience of a medical center in the past 2 decades. J Chin Med Assoc. 2010;73:634-7.

4. Jin CQ, Dong HX, Sun ZX, Zhou JW, Dou CY, Lu SH, et al. Acute immune thrombocytopenic purpura as adverse reaction to oral polio vaccine (OPV). Hum Vaccin Immunother. 2013;9:1739-40.

5. Akbayram S, Karaman K, Ece Ý, Hatice Akbayram T. Acute immune thrombocytopenic purpura following oral polio vaccination. Platelets. 2015;26:705.

 

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